The home as an appropriate setting for women undertaking cervical ripening before the induction of labour.

Public Health and Health Policy, Division of Community Based Sciences, University of Glasgow, Glasgow, UK.
Midwifery (Impact Factor: 1.12). 02/2011; 27(1):30-5. DOI: 10.1016/j.midw.2009.11.003
Source: PubMed

ABSTRACT to explore women's experiences of cervical ripening using isosorbide mononitrate (IMN) in the home as part of the main randomised controlled trial.
qualitative study with semi-structured interviews carried out at three weeks post partum. Interview transcripts were analysed to identify recurrent themes, focusing on why women became involved in the study, their views about both the self-medication and the home setting, and whether they would repeat the experience.
the home.
twenty women enrolled in the main randomised controlled trial.
the study is part of a double-blind randomised controlled trial with 350 patients investigating whether a nitric oxide donor (IMN) used in cervical ripening improves the process of induction of labour.
women liked the opportunity to remain at home during the cervical ripening process. Timing and setting were central issues; women hoped that it would hasten labour, while the home was seen as a setting offering freedom, security and reassurance, as opposed to the hospital, seen as constraining. Two women reported problems with IMN but the remainder reported that they would repeat the experience.
women were very positive about the opportunity to undertake cervical ripening at home. It is important to explore this setting further for appropriate interventions.

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    ABSTRACT: Objective To compare clinical outcomes from outpatient with inpatient cervical prostaglandin E2 ripening for low risk labour induction.DesignRandomised controlled trial.SettingTwo tertiary hospitals in Adelaide, Australia.PopulationWomen with uncomplicated term pregnancies, scheduled for induction of labour for reasons of post-dates or for social reasons.Methods Eight hundred and twenty-seven women were randomised at induction decision to an outpatient or inpatient group. All women had CTG monitoring before and after vaginal PgE2 administration. The inpatient women were admitted and the outpatient group was discharged home overnight with instructions to return if labour established or rupture of membranes occurred. Next morning, outpatient women were admitted for rupture of membranes or further ripening. After membrane rupture, both groups received routine care.Main outcome measuresOxytocin use, maternal and fetal outcomes, and whether planned outpatient management was achievable.ResultsThere were no significant differences in oxytocin use (2.5% difference, CI−4.3 to 9.4), caesarean sections (−0.59% difference, CI−6.3 to 5.1), epidural use (1.5% difference, CI−5.1 to 8.2), vaginal delivery within 24 hours (−8.2% difference, CI−17.6 to 1.3) or labour complications. More than half of the randomised women did not receive the intervention as they laboured spontaneously, or did not require ripening. The post-hoc analysis of women who received ripening also indicated no statistically significant differences in the patterns or results, with the exception of outpatient women having a longer mean length of active labour (mean difference 66 minutes, CI 4–128 minutes). Outpatient women who received ripening were diagnosed more frequently with non-reassuring CTG monitoring and hyperstimulation, with less than half of the women going home and remaining home overnight.Conclusions This study demonstrated no clinical advantage or disadvantage in prostaglandin E2 outpatient cervical ripening. Uterine stimulation following prostaglandins may preclude a woman from going home or remaining at home overnight and may not be the best agent for outpatient ripening.
    BJOG An International Journal of Obstetrics & Gynaecology 05/2014; 122(1). DOI:10.1111/1471-0528.12846 · 3.76 Impact Factor
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    ABSTRACT: Induction of labor, an increasingly common intervention, is often preceded by the application of an agent to "prime" or "ripen" the cervix. We conducted a randomized controlled trial to compare clinical, economic, and psychosocial outcomes of inpatient and outpatient cervical priming before induction of labor. In this paper we present the psychosocial outcomes. Women participating in a randomized controlled trial in two Australian metropolitan teaching hospitals completed questionnaires to measure anxiety and depression at enrollment, and to examine satisfaction, experiences, depression, and infant feeding 7 weeks after giving birth. Data analysis was by intention to treat and by having received the intervention as intended (approximately 50% in each group). Of 1,004 eligible women, 85 percent consented (n = 407, outpatient; n = 414 inpatient). No statistically significant or clinically relevant differences were found in immediate anxiety, depression, or infant feeding. Small, statistically significant differences favoring outpatient priming were found in seven of the nine subscales in the 7-week postpartum questionnaire. The direction of the effect was maintained, mostly with a larger effect size in women who received the intervention. Women allocated to outpatient priming were more satisfied with their priming experience than women allocated to inpatient priming. Being informed that they could go home after cervical priming did not increase women's anxiety.
    Birth 06/2013; 40(2):75-80. DOI:10.1111/birt.12035 · 2.93 Impact Factor
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    ABSTRACT: OBJECTIVE: To evaluate whether home cervical ripening is safe and results in shorter hospital stay. METHODS: This was a retrospective cohort study of women with singleton pregnancies having induction of labor for postmaturity at a single center between January 2007 and June 2010. Women were offered home cervical ripening with 1 mg dinoprostone gel if they were nulliparous, had uncomplicated singleton pregnancies, and the indication for induction was postmaturity. RESULTS: Nine hundred seven of 1,536 (59.1%) nulliparous women having induction of labor for postmaturity were eligible for home cervical ripening. The median number of hours at home was 11.76 hours (range 0-24.82 hours). There were no cases of birth outside of the hospital, uterine rupture, or significant neonatal morbidity or neonatal death related to home cervical ripening. Eighty-five (5.5%) women who underwent hospital cervical ripening because of maternal preference or social issues formed a hospital cervical ripening comparison group. There was no significant difference in the total number of hours before delivery spent in the hospital between the two groups (26.25; 95% confidence interval [CI] 25.27-27.23 in home cervical ripening group compared with 24.28; 95% CI 22.5-26.0 in the hospital group; P=.26). CONCLUSIONS: Clinical outcomes are comparable in nulliparous women who receive a single dose of dinoprostone gel for home cervical ripening compared with those who undergo hospital cervical ripening. However, preadmission home cervical ripening with 1 mg dinoprostone does not decrease the number of hours women spend in the hospital.
    Obstetrics and Gynecology 07/2014; DOI:10.1097/AOG.0000000000000394 · 4.37 Impact Factor

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